1. Field of the Invention
The invention relates to an apparatus and the use thereof to assist in the Canalith Repositioning Maneuver.
2. Description of the Prior Art
Approximately 3 million of the 250 million people in the United States suffer from vertigo of some duration each year. Vertigo is the most common physician visit diagnosis in patients over 65 years of age. 17% of patients who have vertigo have benign paroxysmal positional vertigo. Positional vertigo is characterized by vertigo when the patient moves into the effected ear downward position. The patient may also have symptoms of vertigo with looking up or looking down. The diagnosis is clinically confirmed by placing the patient in the effected ear down position and observing a characteristic rotary jerking motion of the eyes. The natural history of positional vertigo is one of spontaneous remission. Recurrence is common and can last for weeks to months. One ear is usually involved but reports of 15% of bilateral ear involvement have been made.
Positional vertigo is caused by dislodgment of naturally occurring inner ear calcium carbonate crystals (121, FIG. 1). When these crystals fall from their normal position in the inner ear (the utricular macula (123), two events that effect one of the inner ear sensors (the posterior semi-circular canal) can occur. (1.) When the patient places the effected ear downward, the loosened crystal (121-L) causes motion of the rotation sensor (127), causing the patient to sense vertigo. (2.) When the patient places the effected ear downward, the loosened crystals (121-B) move together within the membranous semicircular canal (141), and their aggregate effect is to cause motion of the endolymphatic fluid (95). The motion of that fluid and the motion of that fluid in a narrow channel (141), the membranous semi-circular canal of small cross sectional diameter, has a significant effect on the much broader surfaced area (127) rotation sensor, causing the patient to sense vertigo.
In those patients whom multiple loosened crystals (121-B) have collected in the posterior semi-circular canal, a treatment is available.
The presence of loosened crystals (121-B) was identified and their effect on the rotation sensor (127) is explained by John Epley, M.D., approximately eight years ago. Dr. Epley hypothesized and then demonstrated that by rotating the patient's head in the plane of the effected inner ear rotation sensor (the posterior semicircular canal, 131), the loosened crystals (121-B) can be caused to fall through the fluid of the posterior membranous semi-circular canal 141 away from the rotation sensor (127) and fall into the large compartment of the endolymphatic fluid compartment (93) (128) the utricle. In this position crystals delivered by this head rotation maneuver into the utricular portion of the endolymphatic space cause fewer symptoms and presumably dissolve more rapidly than in the membranous posterior semi-circular canal much smaller fluid space (141).
The technique that Dr. Epley described has been reported by multiple authors and is thought to be a good and valid technique.
The performance of this Canalith repositioning maneuver (Eply maneuver) by other physicians or paramedical personnel is difficult to teach. Inconsistent performance and performing this maneuver in an incorrect method is a continuing problem. Consistent performance of this maneuver by the apparatus of the invention allows a method to help paramedical personnel consistently perform the Epley maneuver or allows the patient to perform the maneuver consistently without supervision.
The literature reports that the use of a head vibrator for some period of time prior to performance of an Canalith repositioning maneuver increases the efficiency of the movement of the loosened crystals (121-B) from the posterior semi-circular canal membranous labyrinth into the utricle. A vibrator can be attached to the apparatus of the invention. The vibrator may be attached internally or externally to the apparatus.